Unfortunately many people are at a loss at what to do when they get a diagnosis of arthritis. Whether it is in the hands, knees, hips, or elsewhere, arthritis can take a large toll on being able to move and perform the activities you want to do on a daily basis, besides sometimes having constant pain. The pharmaceutical options for arthritis usually involve NSAIDs, which sometimes do help with the pain, but rarely help to reverse the condition and can come with bad side effects such as stomach ulcers and liver toxicity.
While there are many natural options for arthritis, the most well known is probably glucosamine, sometimes mixed with chondroitin and MSM. While these supplements do seem to have somewhat of a beneficial effect in treating arthritis, the effect size is usually minimal or modest. 
One natural treatment option that is not as well known today is niacinamide, a form of vitamin B3.
It may seem unlikely, but this vitamin not only has a history of getting thousands of people out of psych wards are “cured” from pellagra in the early 1900s, but also has been shown to be quite effective for joint pain and arthritis.
The first known clinical use of niacinamide for arthritis was back in the 1930’s by Dr. William Kaufman.(8) He was a very detailed physician and meticulously recorded and documented the progress that was made by his patients when taking niacinamide for joint pain and arthritis. He treated a plethora of patients with this simple vitamin, and usually got very encouraging results. While the treatment didn’t “cure” everyone, it usually at least made a dent in their pain or ability to move. (You can read all of his notes for free online here.)
There wasn’t much formal research about niacinamide and joint pain besides Dr. Kaufman’s work and the case studies of some other physicians until the 90’s. In 1996, there was a pilot study on niacinamide for osteoarthris with a total of 72 patients taking either 1g X 3 of niacinamide or placebo per day. The outcomes were positive, and the researchers concluded:
“Niacinamide improved the global impact of osteoarthritis, improved joint flexibility, reduced inflammation, and allowed for reduction in standard anti-inflammatory medications when compared to placebo. More extensive evaluation of niacinamide in arthritis is warranted.”(2)
Shortly after this first promising study came a cell study where the researchers tried to figure out exactly how niacinamide might be helping with joint pain and inflammation. In 1999, a paper came out hypothesizing that the beneficial effect of niacinamide on arthritis and joint pain was from a reduction of IL-1 induced nitric oxide. (3)
Both IL-1 and nitric oxide have been known to be involved in joint inflammation, and there are numerous studies showing that niacinamide inhibits both of them, along with other pro-inflammatory cytokines. (4, 5, 6, 7)
While niacinamide usually does show at least some effect for joint pain and mobility, Kaufman urged that high frequency doses should be tried for at least 3 months before abandoning niacinamide therapy, as some joints are slow to heal.
There are a couple things to keep in mind if you want to try niacinamide therapy for joint pain:
The first is the dose. Kaufman discovered through much trial and error that the frequency of the doses are very important, sometimes even more important than the total dose.
In the clinical trial, they used 1g x 3 a day. Kaufman never once used a dose like this. He always advocated small doses taken frequently. For severe patients, he would give a dose every hour, or sometimes even every half hour!
This can be inconvenient for many people, but for those with severe, debilitating joint pain, it may be worth trying a dose every hour or every 30 min, at least for a few weeks before dropping the dose down.
My usual recommendation is to buy the cheap 500mg pills found online. Take about 5-6 of these spread out throughout the day. If you so prefer, you can also buy the 250mg pills instead with the same dosing regimen or even a higher frequency one.
Source Naturals also has a time-released version of niacinamide that you can try. For these, I would recommend 1 pill of the 1000mg times 3 a day. Kaufman claimed that the time-released didn’t get broken down well enough and were not as effective, however that was many decades ago. The time-released available now may work better, but there are no studies that have tested them currently.
Of course, before beginning any new supplement, make sure to talk to your primary care physician about it. None of this is intended as medical advice and is for informational purposes only.
The second thing to keep in mind when taking niacin or niacinamide is that they eat up methyl groups. I’ve talked about this in other articles, but the main point is that niacinamide will use up methyl groups in order to be excreted from the body. This occurs in the liver, and when the liver gets low on methyl groups, it has a harder time protecting itself from stresses and liver enzymes can go up. Blood sugar can go up as well.
In order to prevent these side effects, I always recommend that trimethylglycine (aka betaine, aka TMG) be dosed with niacinamide at a 1:1 ratio or higher. So if the total dose of niacinamide is 3g a day, then take at least 3g of TMG as well. The best regimen for TMG is to split the dose in half, morning and night, but if you just want to take it all at once it isn’t that big of a deal.
TMG replenishes the methyl groups that niacinamide is using up, thus preventing the side effects from niacinamide. For those with severe methylation issues, adding in methyl-b12, b6, methyl-b9, and possibly MSM will further help the methylation cycle run smoothly. For most people though, just TMG will be enough. To be cautious, you may want to check your liver enzymes and homocysteine levels after being on niacinamide for a year or so.
While there are many alternative treatments out there claiming success with arthritis, not many have the historical success and liturature to support it like niacinamide does. While this is just one of niacinamide’s many benefits, it can be a life-saver for many with debilitaing pain and restriction. If dosed how explained above, any side effects are very minimal, and a routine blood test will catch them. For any of you with joint pain in the hands, knees, hips, back, neck, or wherever, it may be worth a try to test niacinamide!
I would love to hear from any of you with any experience you have had with niacinamide for joint pain in the comments below. You can also leave any questions you might have.
1. Vasiliadis HS, Tsikopoulos K. Glucosamine and chondroitin for the treatment of osteoarthritis. World J Orthop. 2017;8(1):1-11. Published 2017 Jan 18. doi:10.5312/wjo.v8.i1.1
2. Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: a pilot study. Inflamm Res. 1996 Jul;45(7):330-4. PubMed PMID: 8841834.
3. McCarty MF, Russell AL. Niacinamide therapy for osteoarthritis–does it inhibit nitric oxide synthase induction by interleukin 1 in chondrocytes? Med Hypotheses. 1999 Oct;53(4):350-60. PubMed PMID: 10608273.
4. Duan D, Yang S, Shao Z, Wang H, Xiong X. Protective effect of niacinamide on interleukin-1beta-induced annulus fibrosus type II collagen degeneration in vitro. J Huazhong Univ Sci Technolog Med Sci. 2007 Feb;27(1):68-71. PubMed PMID: 17393114.
5. Xiong X, Yang S, Shao Z, Liu X, Zhan Z, Duan D. Up-regulation of niacinamide in intervertebral disc aggrecan in vitro. J Huazhong Univ Sci Technolog Med Sci. 2006;26(1):89-92. PubMed PMID: 16718929.
6. Ungerstedt JS, Blömback M, Söderström T. Nicotinamide is a potent inhibitor of proinflammatory cytokines. Clin Exp Immunol. 2003 Jan;131(1):48-52. PubMed PMID: 12519385; PubMed Central PMCID: PMC1808598.
7. Eizirik DL, Sandler S, Welsh N, Bendtzen K, Hellerström C. Nicotinamide
decreases nitric oxide production and partially protects human pancreatic islets against the suppressive effects of combinations of cytokines. Autoimmunity. 1994;19(3):193-8. PubMed PMID: 7605871.
8. Saul, A.. The Pioneering Work of William Kaufman: Arthritis and ADHD. Orthomolecular Medicine. 2003